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(704) 632-8012
415 Remount Rd Charlotte, NC
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Canine Wellness
Step 1 of 2
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Date
*
Date Format: MM slash DD slash YYYY
Pet's Name
*
Name
*
First
Last
Email
*
Phone
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Has your pet been to another veterinarian or emergency vet since we last saw them?
Yes
No
If yes, please list.
Does your pet participate in any of the following activities?
*
Dog Parks/Dog Bars
Daycare/Boarding
Grooming
Hiking
Swimming
Drinking from ponds/puddles/shared water
Traveling
None of the Above
What kind of food does your pet eat? How much in a day? Please list any treats as well.
(ie, dry, canned, purina, science diet, 3 cups once a day, 2 cups twice daily, etc)
Any current medications and/or supplements?
Please include any flea, tick, & heartworm medication.
Have you missed any monthly heartworm prevention?
Yes
No
Unsure
Do you need any refills?
Yes
No
Have you seen any fleas or ticks on your pet?
Yes
No
Unsure
Any of the following symptoms?
Vomiting
Diarrhea
Coughing
Sneezing
Itchy/Scratching
Any changes in your pet's weight?
Increased
Decreased
No Change
Any changes in your pet's activity/energy level?
Increased
Decreased
No Change
Any changes in your pet's appetite?
Increased
Decreased
No Change
Any changes in your pet's water intake?
Increased
Decreased
No Change
Any additional information you would like to make the medical team aware of?
Upload any documents or pictures that may help the medical team here.
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New Clients
What To Expect
About Us
FAQs
Testimonials
Let us know how we did!
Services
Wellness Care
Preventive Services
Medical Services
Surgical Services
Anesthesia and Patient Monitoring
Nutritional Counseling
Additional Services
Pet Health
Pet Health Library
Interactive Animal
Breed Info
Videos
News
Pet Health Checker
Forms
New Client Registration Form
Prescription Refill & Food Order Request
Canine Wellness Form
Feline Wellness Form
Contact
Shop Online Pharmacy
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